Cal. Code Regs. Tit. 22, §§ 2712-1

Current through Register 2024 Notice Reg. No. 50, December 13, 2024

Section 2712-1 - Dispute Between Department and a Voluntary Plan Where Claim Filed with the Department

(a) If an individual files a claim for disability benefits or Family Temporary Disability Insurance benefits with the department and the department determines that the claimant is eligible for benefits, but that such benefits are payable from a voluntary plan and not from the Disability Fund, the department shall immediately forward a copy of the claim and any medical and other records relating thereto to the voluntary plan insurer, or employer if it be a self-insured plan, with a request that benefits be paid from the voluntary plan. If any payment has been made from the Disability Fund, a statement of such payments and a request for reimbursement shall also be forwarded with the copy of the claim. If the voluntary plan insurer or self-insurer concedes coverage and eligibility, prompt reimbursement shall be made to the Disability Fund and the claimant shall be promptly paid the accumulated excess of benefits, if any, to which he or she is entitled. If the voluntary plan insurer or self-insurer denies coverage, it shall immediately so notify the department and the claimant in writing, giving its reason for the denial and, in such event, the department shall immediately pay benefits under the claim.

(b) If a voluntary plan insurer or self-insurer fails to give notice of acceptance or denial of coverage within twenty-five (25) days after a copy of the claim is mailed or delivered to it, as provided in subdivision (a) of this section, such failure shall be deemed to be a denial of coverage, and the department shall immediately pay benefits under the claim.

1. New section filed 3-14-66; designated effective 3-24-66 (Register 66, No. 7).
2. Amendment of subsection (a) filed 4-1-82; effective thirtieth day thereafter (Register 82, No. 14).
3. Amendment of subsection (a) filed 7-1-2004 as an emergency; operative 7-1-2004 (Register 2004, No. 27). A Certificate of Compliance must be transmitted to OAL by 10-29-2004 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 7-1-2004 order transmitted to OAL 10-25-2004 and filed 12-2-2004 (Register 2004, No. 49).

Note: Authority cited: Sections 305, 306 and 2602, Unemployment Insurance Code. Reference: Section 2712, Unemployment Insurance Code.